Article excerpt

INTRODUCTION

Several U.S. agencies and departments implement global health interventions. With the exceptions of initiatives to fight HIV/AIDS through the President's Emergency Plan for AIDS Relief (PEPFAR), malaria through the President's Malaria Initiative (PMI), and pandemic flu through the Avian Flu Task Force, the funding and implementation of U.S. global health initiatives are not always coordinated among agencies and departments. There is a growing consensus that U.S. foreign assistance needs to become more efficient and effective. There is some debate, however, on the best strategies. As Congress considers how best to improve foreign assistance, some Members are attempting to identify the scope and breadth of U.S. global health assistance [1]. This report highlights the global health efforts that the Centers for Disease Control and Prevention (CDC) undertakes, outlines how much CDC has spent on such efforts from FY2001 to FY2009, highlights FY20 10 budget proposals from the Administration, House, and Senate Appropriations Committee, and discusses some issues the 111th Congress and the incoming director face.

Since 1958, CDC has been engaged in global health efforts. At first, CDC's global health engagement focused primarily on malaria control. CDC's global health mandate has grown considerably since then. In 1962, CDC played a key role in the international effort that led to smallpox eradication and in 1967 expanded its surveillance efforts overseas to include other diseases, when the Foreign Quarantine Service was transferred to CDC from the U.S. Treasury Department [2] As CDC's mission expanded, so have the authorities under which it operates [3]. Today, CDC is a partner in a number of global disease control and prevention efforts, including those related to HIV/AIDS, influenza, polio, measles, and tuberculosis (TB). In addition to its work in controlling the spread of infectious diseases, CDC's global health efforts aim to address other global health challenges, such as chronic disease, injury prevention, child and maternal health, and environmental health concerns.

CDC'S GLOBAL HEALTH PROGRAMS

Congress provides funds to CDC for global health efforts through Labor, Health and Human Services (HHS), and Education appropriations. The bulk of funds for CDC's global health programs are provided through five main budget lines: Global HIV/AIDS, Global Malaria, Global Disease Detection, Global Immunization, and Other Global Health. In practice, CDC does not treat its domestic and global programs separately. Instead, it uses the same experts to address domestic and global health issues. As such, CDC is engaged in a wider range of activities than what Congress appropriates for global health initiatives.

CDC programs are implemented bilaterally and in cooperation with other U.S. agencies, international organizations, foreign governments, foundations, and nonprofit organizations [4]. In addition to the funds Congress provides to CDC for global health programs, the Office of the Global AIDS Coordinator (OGAC) at the U.S. Department of State transfers funds to CDC as an implementing partner of PEPFAR, which is implemented by a number of agencies and departments [5]. U.S. Agency for International Development (USAID) also transfers funds to CDC as an implementing partner of PMI [6] The section below describes global health activities that Congress funds CDC to implement.

Global HIV/AIDS

CDC launched its Global AIDS Program (GAP) in 2000 under the LIFE Initiative [7]. GAP supports HIV/AIDS interventions in 41 countries and offers technical assistance in an additional 29 others [8] To combat HIV/AIDS, CDC sends clinicians, epidemiologists, and other health experts to assist foreign governments, health institutions, and other entities that work on a range of HIV/AIDS-related activities. The key objectives of GAP are to help resource-constrained countries prevent HIV infection; improve treatment, care, and support for people living with HIV; and build health care capacity and infrastructure. …